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General NPI Number Information
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NPI Number | 1487859658
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Entity Type | Individual
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Provider Name | CHARLES STEPHEN WILSON M.D
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Gender | Male
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1500 S 48TH ST
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City | LINCOLN
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State | NE
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Zip | 68506-1225
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Country | US
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Telephone | 402-481-8944
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Fax |
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Provider Business Mailing Address
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Address Line | 7430 N HAMPTON RD
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City | LINCOLN
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State | NE
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Zip | 68506-1624
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Country | US
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Telephone | 402-488-9181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 12283
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License Number State | NE
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